A federal judge on Monday abandoned the mandate of staffing at national nursing homes and considered how to quickly shift providers and use freedom from flexible requirements to restructure and modernize the workforce.
Judge Matthew J. Kaxmalick of the U.S. District Court in Northern Texas found four nursing homes, the American Medical Association and Reading Wedges, and found that the 24/7 requirement for registered nurses exceeded the authority of the Centers for Medicare and Medicaid Services.
“The court has confirmed that CMS does not have the authority to issue such staffing requirements — only Congress does. Therefore, we are now calling on Congress to act,” Cliff Porter, president and CEO of the American Medical Association/Assisted Living Center, said in a statement. “In light of evolving care practices and changing demographics in our country, federal policymakers should encourage innovation and high-quality outcomes rather than determining staffing times. The staffing mission is a 20th century solution that Congress should never block.”
Both major nursing home associations are holding face-to-face events this week, and both providers responded to the bailout as news of the much-anticipated ruling was destroyed. In Washington, D.C., a record 750 aging service providers were attending the Leading Ways Leadership Summit, with many planning to raise concerns about staffing rules during their planned visit with federal lawmakers on Wednesday.
“Our stance has always been clear. It's wrong to impose a mandate rather than addressing the sufficiency of the funding and workforce,” said Katie Smith Sloan, president and CEO of Reading, who held the opening reception when the news broke.
“I took part in this lawsuit because it ignored the critical interdependence of funding, care, staffing and quality, and had a serious impact on the ability of nursing home members to provide the care and services they provide daily, along with providers of other care settings such as home health and hospice. “This overreach rule is misguided, and today's ruling demonstrates the importance of a thoughtful and sustainable pathway that supports both quality of care and workforce development.”
At the AHCA Quality Summit in Atlanta, the crowd gave a literal standing ovation when board chair Phil Scalo announced the verdict around 6pm.
Porter later called the measure “an unrealistic staffing power of attorney that threatened to close nursing homes and drive away vulnerable elderly people.”
“As I said from the start, nursing homes want to hire more nurses and caregivers. Despite the limited resources, we do everything in our strength to increase our workforce,” he added, vowing “Our work is not finished.”
Details of the award
The court granted their victory to the provider in a summary judgment which also denied the defendant's cross-motion for summary judgment. This case, which deviated entirely based on written arguments, was dismissed for bias.
The regulations increased the hourly total requirement for direct patient care and required staff to have RNs 24 hours a day at all nursing homes across the country. In particular, rural providers have problems with their regulations given that there is only one RN in the current healthcare environment.
Federal regulations set by Congress require that all nursing homes currently have eight hours of hand at hand per day.
“CMS does not have the authority to issue regulations that replace the minimum council's priority hours, which is exactly the 24/7 requirement,” Kacsmaryk ruled in Monday's ruling in favour of nursing home plaintiffs. “The council took itself to set up a minimum-hour nursing home where “registered professional nurse services must be used.” ”
Kacsmaryk referenced the prosecution's hourly minimum as a “fill in details” scenario.
“Institutions lack the authority to consider the nursing 'needs' of facilities when prescribing minimum personnel standards,” he writes. “The Council has stipulated that “the nursing needs of (institutional) residents” must be considered as “the (Rlequired Nursing Care” standards.” …This provision specifically governs the minimum standards for nurses.”
The judge added that the HPRD requirements of staffing rules attack part of the law as they do not take into account the nursing needs of facility residents.
The decision is sure to spark hail of complaints from unions, many consumer groups, and supporters of staffing rules, including prominent Democrats in Congress.
Sam Brooks, director of public policy for National Consumer Voices for Quality Long-Term Care, confirmed on LinkedIn on Monday that it was “sadly” vacant.
“This modest rule will prevent pressure ulcers for nearly 14,000 people, reduce hospitalizations and improve the lives of hundreds of thousands of elderly home residents,” he wrote. “In spite of this verdict, we will fight to protect our most vulnerable citizens.”
I'll move forward
But while there were opponents of the rules on both sides of the political aisle, it is particularly difficult to realize the minimum staffing provisions for staffing, including lawmakers from many rural states. In addition to directing compensation for nurses registered 24 hours in all skilled US nursing facilities, operators must provide 3.48 hours of direct patient care per day.
President and CEO Nate Schema at Good Samaritan Society, the country's largest non-profit provider of nursing home services, told McKnight's long-term care news that he hopes staff from leadership to frontlines will now sigh from Ah Relief. The 500-1,000-person rural town offered by Good Sam makes it easier to rest, knowing that the neighborhood nursing home is coming out of the dark clouds.
“This is certainly a great prospect for the elderly, their families, and for us in the countryside of America,” he said Monday. “I think this decision will protect access to care and open up a more thoughtful approach, a way to improve quality, support caregivers and ensure sustainability for rural providers.”
He said providers can invest in their own local, informed strategies to promote care, whether they focus on building nursing pipelines using meaningful programs or looking at new ways to use technology.
Instead, all numbers in one size could spell out a major challenge for some facilities in the Good Sam footprint. Many of them are the only ones in the community.
“All options would have been at the table. We know that we did everything with our resources caregivers on our own, but we know that if we were strong and realistic, we had to make some discriminatory decisions over time,” Schema said.
Providers may continue to unravel fallouts from the decisions in the coming days and weeks as they will come to understand whether some of the rules other than the hourly rules and RN requirements can still exist if the federal government appeals and if Kakusmalik's decision could shake the outcome of similar cases moving through Northern Iowa District Court.
Given the Republican majority in both Congressional meeting rooms and discrepancies with some rural Democrat rules, there may be a viable path to achieving Porter's wish to block rules entirely. The discussion includes placing abolition on major budget transactions that are currently being abolished.
The Texas ruling has come at a particularly interesting time, with administrative attorneys strictly defending the rules within a week.
The minimum nursing home count began the day before President Biden's 2022 coalition speech when the White House issued a fact sheet pointing to its intention to set the federal government's first standard. The next day, Biden made history by selecting nursing homes in his speech to the country.
